The reason I am so convinced we need a single-payer universal health care system now (basically an expansion of Medicare to everyone in the United States where patients would still choose their doctors) is that my job involves helping people access health care. As a health care social worker, I have to see the cruelty and inhumanity of our current health care system on a daily basis. In a humane society, when someone is diagnosed with an illness they would have a medical support system that allowed them to focus on healing. Instead, most of the people I work with have the tremendous stress of trying to fight the bureaucratic monster that is our health care payment system. They have to fill out endless paperwork (much of which is designed specifically to prevent access and limit payments) and navigate a confusing maze that has many dead ends and often no way out! This creates enormous stress (which has been repeatedly shown to negatively impact the human immune system).
I am fortunate to work in a publicly funded family practice clinic associated with a medical school and a public hospital. This is in a community that also provides many other forms of assistance. However, as there is no universal coverage, all programs are ‘needs based’ and have application processes to qualify. A patient will typically have to fill out at least 2 applications for basic doctor and lab work (however, many specialty doctors and labs do not accept these charity programs). This leaves the patient waiting for applications (which are often available only through the mail), having to fill out applications and wait for approval. Even once approved, these processes provide headaches for our referral clerk who must try to figure out which provider may actually accept the plan they get (similar to insurance company policies, accept providers accepting charity care are constantly changing and are not listed anywhere). Often the main burden falls on the patient. While I am able to help navigate the systems, I work out of an office, so if a patient does not have one of the random documents requested, they will often have to meet with me again or mail it in. Also, I help a lot of people, so just getting an appointment to see me or another social worker, can cause significant delays.
If they need medications that are not available as cheap generics (though even $4 generics can be cost prohibitive if you are unemployed and have multiple meds) they must apply through drug company prescription assistance programs (PAPs). Many of these PAPs are complicated and designed specifically to discourage doctors from using them due to the time it takes to complete them (Johnson & Johnson is one of the worst I have to use regularly). Of course each one is different, requires different forms and has different proof of income requirements. With the cost of the time we put into helping patients with this process, it would probably be almost as cost effective to just buy the medications for the patients. If the pharmaceutical companies actually wanted to help patients, rather just be able to point to a program that they say helps patients, they would fund a centralized approval system and accept regular doctor prescriptions from eligible citizens.
Of course, many people are just over the income requirements of programs and as is the case in disability applications, they often have to lose their house and everything they have worked all their lives for before they can qualify for programs. I am sure you have also seen how even those with insurance often find their coverage is not enough to avoid medical bankruptcy! I have just given a taste of what people have to deal with. There is often Medicare of Medicaid access problems. The people I work with are often trying to find work, pay rent or mortgage, pay utility bills and take care of children or other family members. And of course, they often see me because they have a serious medical condition. I am actually constantly amazed at the positive attitudes some patients can keep up in the face of such adversity. Of course, tht makes me worry even more about those I don’t see because they have given up on a system they feel does not care about them. I am priveleged to connect with and learn from my patients. I am constantly reminded that we are all humans, have the same needs and deserve to be treated with caring and dignity. While it is rewarding when I can help people, I would be happy to have a health care payment system that made most of this work go away. Then I would be able to focus much more on the mental health aspects of my work, that are often difficult to address in individuals who do not have their basic needs met.
As I said, if we lived in a humane society, those who had illness would be cared for and provided with a healing environment. Instead, we provide those most in need with an endless amount of paperwork and related stress on top of their existing stresses of life and medical problems. While I am not much of the religious type, I believe it was Jesus who said something about being judged by how we treat the most unfortunate in society. While I personally find it easy for an agnostic such as myself to see the basic common sense and morality of providing universal health care access, I cannot understand how our politicians, who often claim to be christian, can justify the way our current health care system treats people most in need. Perhaps if they all spent some time doing the social work in the health care system, they would break through their delusions and work now to provide the basic human right of health care to all!
Here is a link to good article on Obama’s abandonment of his support for a single payer health care system:
